PI-06: THE NURSE CHAMPION MODEL FOR NEWBORN SCREENING FOR SICKLE CELL DISEASE IN SUB-SAHARAN AFRICA: AN IMPLEMENTATION SCIENCE PROTOCOL
Authors: JAJA C., IBEMERE S., GIBSON R., EDEM-HOTAH J., VICK L.
Journal: HemaSphere (2022)

Purpose: Sickle cell disease (SCD) is a major contributor to child morbidity and mortality. In Sub-Saharan Africa (SSA) approximately 90% of the children born annually with SCD will die before their fifth birthday, often undiagnosed. The absence of early diagnosis through laboratory-based newborn screening (NBS) programs is a major barrier to the implementation of timely preventive measures in SSA. Emergent, novel, inexpensive, point-of-care tests (POCTs) with validated analytic characteristics and field-tested performance comparable to laboratory methods for identifying SCD present a unique opportunity for implementation of localized, community-based newborn NBS programs in primary health centers (PHCs). Nurses comprise the single largest category of available health workers in SSA. Therefore, we describe a Nurse Champion protocol to provide (1) genetic counseling education, (2) perform sickle cell disease and carrier screening with POCTs, (3) and prompt linkage to care in PHCs. Materials and methods: Our protocol delineates a type-2 hybrid implementation-effectiveness design for the evaluation of feasibility and acceptability of the Nurse Champion model protocol in limited-resource settings. The model’s components are provider capacity education, care support tools, care coordination, and an expert-driven process of professional peer oversight of the nurses. We use the Consolidated Framework for Implementation Research (CFIR) to guide comprehensive pre-implementation evaluation and adaptation of the Nurse Champion protocol. The CFIR provides a structure for understanding barriers and facilitators to successful protocol implementation in a specific setting and enhancing fit with the local context. We combine the CFIR with Implementation Mapping, a protocol that guides the design of multi-level health promotion interventions and implementation strategies. Implementation Mapping posits that the primary and secondary outcomes of implementation and innovation effectiveness depend on logic modeling. We add the Learning Evaluation Model (LEM) to the protocol to establish feedback loops for evaluation and adapt the protocol to contextual changes. Results: Nurse champion models, while evidence-informed, have not been tried in PHCs in SSA for SCD diagnosis. Therefore, we need to know whether nurses can diagnose SCD using POCTs and what kind of training and technical assistance they would require? What characteristics of a SCD POCT intervention will support (a) identification of babies with SCD at birth; (b) broad adoption across primary care settings (including rural and urban); (c) implementation by nurses with moderate levels of training and expertise; (d) replicable effects, and (e) at a reasonable cost? Our protocol outlines multimodal steps to address these questions. Conclusion: The Nurse Champion protocol showcases the wide variety of nursing roles in the early diagnosis of a genetic disease such as SCD with POC diagnostics. The World Health Organization recommends task shifting of clinical roles as a workforce strategy to improve access to services and reduce disparities in healthcare. Task-shifting and upskilling are innovative strategies for enhancing nurses’ knowledge inventory and skills to manage health conditions or coordinate health service delivery. A burgeoning literature supports the effectiveness of nurse-led interventions to improve access to preventive health services. The authors do not declare any conflict of interest